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<?php $current_url = strtolower($_SERVER['SERVER_NAME']); include("config.php"); if(isset($_POST['submit'])){ $applicant_name = $_POST['applicant_name']; $mobile_number = $_POST['mobile_number']; $email_id = $_POST['email_id']; $sql= "INSERT INTO contact_form SET applicant_name ='".$applicant_name."', mobile_number = '".$mobile_number."',email_id ='".$email_id."'"; if (!$result = $conn->query($sql)) { die('There was an error running the query [' . $conn->error . ']'); } $to = "care@gemregistrationportal.org"; // this is your Email address $from = $email_id; // this is the sender's Email address $name = $applicant_name; $mobile_no = $mobile_number; $subject = "Contact Form submission"; //$subject2 = "Contact form submission"; $message = " Applicant Name : " . $name ."\n Mobile Name : ". $mobile_no ."\n Email Id : ". $from ."\n "; //$message2 = "Thank you " . $name . " we will contact you shortly."; $headers = "From:" . $from; // $headers2 = "From:" . $to; mail($to,$subject,$message,$headers); //mail($from,$subject2,$message2,$headers2); // sends the message to the sender echo '<script>alert("Thank you , we will contact you shortly.")</script>'; } ?> <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no"> <meta http-equiv="X-UA-Compatible" content="ie=edge"> <title>Contact Us to Udyam Org</title> <meta name="description" content="Contact us to our team of udyamregiter.in who are always available for you to solve all your Queries. "> <link rel="icon" href="./assets/img/flag.png" type="image/gif" sizes="16x16"> <link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css"> <link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.min.css"> <link href="https://fonts.googleapis.com/css?family=Open+Sans:300,400,600,700,800&display=swap" rel="stylesheet"> <link rel="stylesheet" href="assets/css/style.css"> <style> .container-fluid.fcs-padding-container { background: #ffffff !important; } </style> </head> <body> <?php include 'header.php'; ?> <!-- Tabbar --> <div class="container fcs-form-container"> <div class="container-fluid fcs-padding-container"> <h1 class="text-center mt-3 contact">Contact Us</h1> <div class="card-text" style="margin-top: 30px; text-align: left;"> <div class="row"> <div class="col-lg-5 mx-auto"> <div class="col-lg-12"> <!--<h2 class="text-center">Fill Form to contact Us</h2>--> <form action="contact-us.php" method="post" style="background: #fff3ef;padding: 40px;"> <div class="form-group"> <label>Name:</label> <input type="text" name="applicant_name" class="form-control" required> </div> <div class="form-group"> <label>Mobile No:</label> <input type="tel" name="mobile_number" class="form-control" required> </div> <div class="form-group"> <label>Email: </label> <input type="text" name="email_id" class="form-control" required> </div> <br> <div class="form-group"> <input type="text" name="vercode" class="form-control" placeholder="Verfication Code" required="required"> </div> <div class="form-group small clearfix"> <label class="checkbox-inline">Verification Code <span class="required" onclick="openSOLNumber()" style="cursor: pointer">*</span></label>   <img src="captcha.php"> </div> <!--<label>Message:</label><br><textarea rows="5" name="message" cols="30"></textarea><br>--> <input type="submit" class="btn btn-info rounded-0 sub_btn" name="submit" value="Submit"> </form> </div> </div> </div><br> <div style="font-size:15px; text-align:center"> Email id : <?php echo 'care@'.$current_url;?><br> Phone : 9693821852 <br><br> <b>Note :</b> Please submit you details our representative will get back to you shortly. <br><br> Note : For quick resolution we advise our clients to click <a href="complaint-form.php">Here</a> and submit your grievance. <br><br> <!--Address :BR RT ROAD JUGSALAI, JAMSHEDPUR, East Singhbhum, Jharkhand, 831006--> <!-- ADDRESS : 3RD, H NO 5 SUITE NO. 304, DEV DAS PALACE, BISTUPUR, JAMSHEDPUR, East Singhbhum, Jharkhand, 831001--> </div> </div> </div> </div> <?php include 'footer.php'; ?> <!-- Custom JS --> <script src="./assets/js/nav.js"></script> <script src="./assets/js/util.js"></script> <script src="./assets/js/main.js"></script> </body> </html>

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